The vendors' view: roundtable of long-term care manufacturers and suppliers.
What has been the most important change you have seen in long-term care over the past year?
Several vendors recognized a current trend by facilities to broaden their service offerings and deepen their specialty skills. "There is a growing trend toward diversified service offerings," said Dan Cobb, chief technology officer for HealthMEDX, maker of CareMEDX software. "Skilled providers are building or buying assisted and independent living facilities (and vice versa). They are also branching out into home care, rehab, and adult day services." By the same token, said Cindy Susienka, president and CEO of Golden Innovations, a contract rehab, hospice, and home care provider, "Skilled nursing facilities are working to attract higher-acuity patients by becoming a lower-cost alternative to long-term acute care hospitals, acute care hospitals, and inpatient rehab facilities. We are seeing more capital dollars being put into specialty units to serve this population."
The downside of all this was pointed out by Brooks Smith, president of Medcare Products, maker of patient lifts. "We have seen a number of long-term facilities close during the year," he noted. "Many of these facilities had more operational issues than vacancy issues. The need for quality care has not gone away, but the ability to deliver and afford to deliver that level of care is a continual issue."
Jeff Heaphy, partner and practice unit manager for continuing care for Plante & Moran consultants, finds "further consolidation in the marketplace with providers who are struggling to stay above water looking for exit strategies, most likely sales of buildings or sales of operating rights/CONs to other providers who are able to put in a more efficient cost delivery system for resident care."
Several respondents pointed to a growing interest in product advancement. Sheldon Walle, senior vice-president and general manager of EIDorado National, the bus manufacturer, noted "more interest in upscale products versus a more spartan-type vehicle. This indicates that residents have higher expectations for more and better 'creature features.' Also, styling and aesthetics are of greater importance than in the past. This may be an indication of the increasing affluence and sophistication of the typical resident."
Facility operators are becoming more sophisticated, too, when it comes to information technology. So said many vendors in that field. Typical was the comment from Larry Triplett, president of Resource Systems, developer of CareTracker: "2006 appears to have been the turning point in terms of a new level of technology. Until recently most non mandated technology was either too expensive or too cumbersome for nursing homes to consider for anything other than the mandated function. Technology providers are now providing solutions that solve real issues, such as quality, efficiency, and accountability. Facilities are now able to purchase and implement technology for purposes well beyond what is mandated (i.e., MDS submissions). It appears that 2006 was the year in which the value curve moved above the cost curve."
Robert Greenblatt, chief operating officer of ADL Data Systems, noted, "Over the past year, conversations with new prospects and current clients alike have shown that most facilities are now ready for change. They have found that the implementation of a solid EHR [electronic health record] will provide the most efficient way of sharing data, have that data utilized well across the organization, and that the transition is well worth the effort." Echoing that, Jeff Jordan, managing director of operations at Keane Care, said, "We have clients who have gone as far as technology and state/federal regulations allow to implement electronic medical records. Their enthusiasm and perseverance drive us to deliver more and better software solutions."
Doc Devore, director of research and development at MDI Technologies, finds similar progress from a growing recognition by providers that electronic records will "speed up the charting process and free up their caregivers" and offer better information at the management level"--but, nevertheless, "many still see this as something they will be forced to do."
Looking at it from his market's perspective, Paul Guth, president and COO of Artromick, vendor of automated medication management systems for long-term care, noted, "Artromick has noticed a move toward the investigation of technology and how both pharmacy automation and mobile clinical management software can help the pharmacy and facility thrive in this challenging business environment." As it stands, he added, "Medicare reimbursement pressures have driven the dispensing process into an antiquated model that is wasteful," and "nurses are requesting a [streamlined] medication management system," to which the market has not fully responded, with 30-day medication supplies still the norm.
Do you think there will be significant change in 2007 and, if so, in what way?
Few of the respondents saw significant change for LTC happening in 2007. The most long-term care policy-oriented possibility--and it was a worrisome one--affected rehabilitation services. "Changes, including Part B therapy caps and physician fee schedule reduction," said Golden Innovations' Cindy Susienka, "could have a devastating impact on our collective ability to meet the rehab needs of our residents. The long-term care industry must work together to ensure that payment is appropriate to provide necessary services for beneficiaries. This means a concerted effort aimed at lobbying regulators and legislators. It also means utilizing outcomes data to prove the efficacy of services provided."
Another cautionary note was sounded by Sherry L. Brereton, COO of CARE-TECH Laboratories, provider of such infection control products as SATIN, CARE-CREME, and Orchid Fresh II: "Given the failure rate of systemic antibiotics, as well as today's bariatric and diabetic patient loads, continued and more emphatic [preventive] procedures will be paramount to reducing nursing home costs."
Beyond that, most of the progress seen for next year was product-specific. Some IT vendors saw noteworthy advances into paperless transactions and electronic health records. ADL Data Systems' COO Robert Greenblatt was specific: "As hardware technology advances, so will the ability of electronic health records to capture patient data at the bedside and enable clinicians to perform their jobs faster, quicker, and more efficiently." Hardware advances to expect, he said, include "more advanced tablet PCs, wireless pocket PCs, touch screens, and secure wireless connections," which will "make clinical procedures even easier to document at the point of care, and provide the ability to have that data transmitted instantaneously for use by other departments." Artromick's Paul Guth agreed that "mobile, computerized point-of-care clinical documentation" will begin to advance and that the electronic medication administration record, or eMAR, will gain a market foothold.
Jeff Jordan of Keane Care said, "I anticipate there will be significant progress toward standards development and implementation in 2007. The adoption of the NPI [National Provider Identifier] and UB-04 and the 1500 claim form changes are building a foundation of standardization. I believe we will see more progress toward implementing interface standards in 2007, especially with e-prescribing and NCPDP pharmacy standards. Standardization work will proceed in other areas in support of MDS 3.0."
Alluding to departure alert-type systems, Matthew Center, regional sales manager of Secure Care Products, said, "The next push will be to provide electronic monitoring systems for those individuals who are still under home care. The other major area of concern for long-term care is to provide for the safe monitoring and return of residents who aren't assessed as wanderers or elopement risks, but can go outside and yet may need to be located at the end of the day."
What two or three changes should occur to improve long-term care?
Again, responses seemed more oriented toward specific products, with the IT vendors in particular asserting that anything advancing the adoption of their software and hardware would pay off for facilities both quantitatively and qualitatively. "There is great diversity in IT among LTC providers," noted Keane Care's Jeff Jordan. "Some have made great progress toward an electronic medical record, and some use a computer only to transmit MDS assessments or submit claims. Many more are somewhere in between." Major change, he said, would come from "CMS funding to reimburse providers for implementing technology--hardware, software, and networking. While the U.S. government is currently funding research projects, we hope to see more funds directed to healthcare providers. I also believe in the coordination of efforts to ensure that LTC receives its fair share of funding."
Doc Devore of MDI Technologies said, "Quality care that is cost-effective is crucial to the future of this industry. It is unlikely that we will see decreasing regulations, so it is important that providers partner with the vendor community to develop solutions that will reduce costs and improve care. This means that vendors will have to work together to make their products interoperable by embracing the leading electronic standards for EHR. The LTC community must continue its efforts to make sure that standard-setting organizations consider the needs of long-term care providers. Staff training will be vital to reduce turnover in our industry, and it is exciting to see some of the software solutions that are coming to the market toward this end."
Artromick's Paul Guth said that automation, including the entire medication management process, "in concert with advanced, care-centered software and mobile computing solutions, [comprises] the future and fastest path to improvement in long-term care."
Patrick E. Connolly, president of Sodexho Senior Services, concluded, "One [worthwhile change] was well represented at the recent AAHSA conference in San Francisco: the telling of our story. We need to find new and unique ways to build public perception and support of the tremendous work being done in aging services. Another change would be a continued shift of focus toward resident- or people-centered care. We need to develop programs for the elderly that are focused on improving and enhancing their quality of life."
As might be expected of these entrepreneurs, their approach to LTC's problems was activist; i.e., no waiting for government agencies to relent or for public institutions to do something positive for LTC, no calls for fairer perceptions by the media and the public at large--rather, the field should step up in various ways to change things for the better. Although vendors' overall outlook on the changes in store for LTC was generally modest, by the same token they were probably closer to realism than the vision offered by many Big Picture analysts.
Bottom line: It's up to LTC facilities to shape their own futures, in part by taking maximum advantage of the modern products and services at their disposal.
With thanks to:
Jay Syverson, President and COO
Achieve Healthcare Technologies
Robert Greenblatt, Chief Operating Officer
ADL Data Systems, Inc.
John E. Ederer, President
Kim Stebbings, Vice-President of Sales and Marketing
Anodyne Therapy, LLC
Paul Guth, President and COO
Sherry L. Brereton, COO
CARE-TECH Laboratories, Inc.
Jere C. Ferguson, CEO
Donovan Industries, Inc.
Senior Vice-President and General Manager
Cindy Susienka, President and CEO
Tom Fahey, Vice-President of Sales and Marketing
Health Care Software, Inc.
Dan Cobb, Chief Technology Officer
Jeff Jordan, Managing Director of Operations
Udi Polonsky, CEO
Doc Devore, Director of Research & Development
Brooks Smith, President
Medcare Products, Inc.
Benjamin A. Breier, President
Jeff Heaphy, Partner and Practice Unit Manager for Continuing Care
Plante & Moran, PLLC
Larry Triplett, President
Matthew Center, Regional Sales Manager
Secure Care Products
Arnold Silverman, President
Patrick E. Connolly, President
Sodexho Senior Services
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|Date:||Dec 1, 2006|
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